Needle Pain/Acute & Chronic Pain Flashcards
What is the importance of vaccinations?
vaccination saves lives
-reduced morbidity and mortality in adults, children, and other vulnerable populations
without vaccination ā> outbreaks of disease
protect those who are immunized around them
-infants and other patients who cannot be immunized for medical reasons
What are the barriers to vaccine uptake?
socioeconomic:
-low-income and education level
-young parental age
-birth order of infants
-previous poor vaccine experience
-other significant life stressors
geographic/systematic:
-long distance to clinics
-clinic hours
-translation
Why do vaccine dosages differ for children?
limited by the amount of volume that can be administered intramuscularly
What is the patient age at which pharmacists can inject drugs by advanced method?
5 and older
Pharmacists arent involved in routine vaccination of children, but how can we be involved?
plan for vaccinations - plant the seed
how to prevent needle pain
address concerns
What are some non-pharm therapies for needle pain?
breastfeeding:
-strongly recommended in children 2 and younger
-reduces stress through multiple mechanisms
-cost neutral, can bottle feed
positioning during vaccination (not supine on table)
-skin to skin for neonates
-rocking or holding infants
-children sitting up
distraction:
-key for older children
-games, TV, book, bubbles
-vibration: Buzzy, finger tapping
What are some pharmacological options for needle pain?
topical anesthetics (lidocaine, prilocaine)
sucrose solution
For which age group can we use topical anesthetics for needle pain?
12 and younger
What is the benefit of topical anesthetics for needle pain?
dulls needle pain for the patient
How should topical anesthetics be applied for needle pain?
apply before going to the clinic
-onset time differs between products
read product monograph
What can help increase the absorption of topical anesthetics?
occlusion
For which age group can we use sucrose solution for needle pain?
2 years and younger
What is the MOA of sucrose solution for needle pain?
unknown but thought to involve release of endogenous opioids
How can sucrose solution be made at home?
mix 1 packet of sugar with 2 teaspoons of water
-then draw up syringe and give a few drops on tongue
True or false: even if all the pharmacological and non-pharmacological options are used for needle pain, not all the pain can be prevented
true
What are the consequences of acute pain in children?
avoidance of medical care later in life
chronic pain
-mental illness, opioids, SES disparities
increased health system costs
infants/children identified as high risk of inequitable and poor-quality pain management
Describe the pathophysiology of pain in children.
nociceptive system has increased excitability and sensitization when compared to adults
greater degree of plasticity
descending inhibition is delayed
exaggerated reflex responses which can cause sensitivity
perception of pain may be more influenced by developmental, social, and psychological factors
How can we asses pain in children?
developmentally appropriate tool
-repeat assessment post-intervention
-self report instead of proxy (caregiver) when possible
What are some examples of pain scales?
numeric rating scale (NRS-11)
color analogue scale (CAS)
faces pain scale-revised (FPS-R)
How should we observe pain in pre or non-verbal children?
observational pain measures:
-changes in facial expressions, cry, irritability, sleep disturbance, inactivity
-use in tandem with caregiver who is familiar with the child
What is the non-pharm approach to pain in paeds?
3 Pās (physical, psychological, pharm)
What are the first line options for acute pain in paeds?
ibuprofen or acetaminophen
-pick a suitable dosage form and dose
-monotherapy or co-therapy for more severe pain
ibuprofen more effective
What is an important tool when escalating therapy for acute pain in children?
opioids
-never use codeine
-combine with non-opioid
-three days or 5-10 doses
Describe good monitoring for acute pain in kids.
assess pain at first encounter and then regular assessment
use same scale each time
What is chronic pain?
pain for greater than 3 months
What are the most common forms of chronic pain in paeds?
headache
abdominal
MSK
What is the evidence for neuropathic pain in paeds
limited
